| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 726.91 KB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução: O conhecimento é o caminho para a prática de especialização em Enfermagem Médico-
Cirúrgica, tendo em conta o desenvolvimento de competências comuns e específicas perante a pessoa
em situação crítica. Este é o percurso para a prática de uma enfermagem especializada e avançada,
sendo essencial para promover cuidados eficazes, seguros e de elevada qualidade. Os enfermeiros
usam o pensamento crítico ao aplicar o conhecimento e a prática com base nas evidências,
potenciando um processo de enfermagem competente. Foi neste âmbito que se realizaram os estágios
em contexto de Cuidados Intensivos e em Contexto de Urgência, sendo estes dois espaços de
desenvolvimento profissional e pessoal. Compreender o uso do conhecimento na prática quotidiana de
enfermagem é importante para a melhoria da qualidade da assistência à saúde. Neste sentido, surge
o estudo do “Índice de gravidade da pessoa vítima de queda que recorre ao serviço de urgência”.
Objetivos: Caracterizar o contexto sociodemográfico da pessoa vítima de queda que recorre ao
Serviço de Urgência; identificar as determinantes clínicas das pessoas vítimas de quedas que recorrem
ao Serviço de Urgência; determinar o índice de gravidade da pessoa vítima de queda que recorre ao
Serviço de Urgência; analisar a influência das características sociodemográficas, de contexto e clínicas
no índice de gravidade da pessoa vítima de queda que recorre ao Serviço de Urgência.
Métodos: A natureza do estudo é quantitativa, de coorte retrospetivo, descritivo e correlacional, com
recolha de dados clínicos para identificar o índice de gravidade da pessoa vítima de queda que recorreu
ao Serviço de Urgência do Centro Hospitalar Tondela-Viseu, durante 1 de janeiro a 31 dezembro de
2020, através do software Alert®, causa de admissão no secretariado “queda” e na consulta dos
episódios de urgência. Obteve-se uma amostra de 679 pessoas vítimas de queda, maioritariamente
feminina (54,1%), com uma idade média de 69,61 anos, com predomínio da faixa etária superior aos
80 anos (35,6%). A recolha de dados ocorreu entre 1 de setembro a 1 dezembro de 2021, com registo
numa grelha elaborada ad hoc.
Resultados: A maioria dos utentes foi levada para o Serviço de Urgência na ambulância (63,1%), com
um claro predomínio dos que foram transportados de maca (83,6%). O fluxograma de triagem
prevalecente foi a queda (46,7%), com o discriminador de dor severa (61,1%), triados com prioridade
laranja (98,4%), com área clínica urgente (81,1%) e especialidades de ortopedia (43,4%) e cirurgia
(46,3%) em maior representatividade. Em relação ao diagnóstico de admissão, prevalecem as fraturas
do fémur (19,0%), outros traumas e fraturas não especificadas (17,4%) e traumatismo cranioencefálico
e traumas faciais (13,8%). Domínio das fraturas de ossos longos (34%), seguindo-se outros traumas
(22,1%). O Índice de Gravidade corresponde a um score mínimo de 3,51 e um máximo de 7,84, com
uma média centrada nos 7,34. As variáveis sociodemográficas não interferiram estatisticamente no
Índice de Gravidade e as variáveis clínicas com interferência estatística foram a prioridade e a área
clínica. Os utentes com prioridade laranja, com área clínica de pequena cirurgia e cuja especialidade
foi a ortopedia apresentaram um Índice de Gravidade mais elevado.
Conclusão: As variáveis preditoras do Índice de Gravidade foram a idade, a frequência cardíaca, a
dor, o Índice de reatividade de Glasgow, PaCO2, hemoglobina e bicarbonatos, a tensão
arterial sistólica, pH e PaO2. A idade, a frequência cardíaca, a dor, o Índice de reatividade de Glasgow,
a PaCO2, a hemoglobina e bicarbonatos estabelecem com o Índice de Gravidade uma relação indireta,
enquanto a tensão arterial sistólica, o pH e PaO2 estabelecem uma relação direta. Assim, constatouse
que à medida que aumenta o Índice de Gravidade melhor é a sobrevida das vítimas de queda
atendidas no Serviço de Urgência.
Palavras-chave: Queda; Serviço de Urgência; Índice de gravidade; Enfermagem.
Abstract Introduction: Knowledge is the path to specialised practice in Medical-Surgical Nursing, taking into account the development of common and specific skills towards the person in critical condition. This is the path to specialized and advanced nursing practice, and is essential to promote effective, safe, and high-quality care. Nurses use critical thinking when applying evidence-based knowledge and practice, enhancing a competent nursing process. It was in this context that the internships in Intensive Care and Emergency settings took place, these being two spaces for professional and personal development. Understanding the use of knowledge in everyday nursing practice is important for improving the quality of health care. In this sense, the study of the "Severity index of the person who falls in the emergency department" was conducted. Objectives: To characterise the socio-demographic context of fall victims attending the Emergency Department; to identify the clinical determinants of fall victims attending the Emergency Department; to determine the severity index of fall victims attending the Emergency Department; to analyse the influence of socio-demographic, contextual and clinical characteristics on the severity index of fall victims attending the Emergency Department. Methods: This is a quantitative, retrospective cohort, descriptive and correlational study, with clinical data collection to identify the severity index of fall victims who used the Emergency Department of the Centro Hospitalar Tondela-Viseu, from January 1 to December 31, 2020, using the Alert® software, the cause for admission to the "fall" secretariat and the consultation of emergency episodes. We obtained a sample of 679 fall victims, mostly female (54.1%), with a mean age of 69.61 years, predominantly over 80 years old (35.6%). Data collection occurred between September 1 and December 1, 2021, recorded in a grid prepared ad hoc. Results: Most users were taken to the ER by ambulance (63.1%), with a clear predominance of those transported on a stretcher (83.6%). The prevalent triage flowchart was the fall (46.7%), with the discriminator of severe pain (61.1%), triaged with priority orange (98.4%), with urgent clinical area (81.1%) and specialties of orthopedics (43.4%) and surgery (46.3%) in greater representation. Regarding admission diagnosis, femur fractures prevail (19.0%), other trauma and unspecified fractures (17.4%) and head and face trauma (13.8%). Long bone fractures dominated (34%), followed by other traumas (22.1%). The Severity Index corresponds to a minimum score of 3.51 and a maximum score of 7.84, with a mean centered on 7.34. The sociodemographic variables did not interfere statistically in the Severity Index and the clinical variables with statistical interference were priority and clinical area. Patients with priority orange, with minor surgery and whose specialty was orthopedics had a higher Severity Index. Conclusion: The predictor variables of the Severity Index were age, heart rate, pain, Glasgow Reactivity Index, PaCO2, hemoglobin and bicarbonates, systolic blood pressure, pH and PaO2. Age, heart rate, pain, Glasgow Reactivity Index, PaCO2, hemoglobin, and bicarbonates establish an indirect relationship with the Severity Index, while systolic blood pressure, pH, and PaO2 establish a direct relationship. Thus, it was found that as the severity index increases, the better the survival of fall victims treated in the Emergency Department. Keywords: Fall; Emergency Department; Severity Index; Nursing.
Abstract Introduction: Knowledge is the path to specialised practice in Medical-Surgical Nursing, taking into account the development of common and specific skills towards the person in critical condition. This is the path to specialized and advanced nursing practice, and is essential to promote effective, safe, and high-quality care. Nurses use critical thinking when applying evidence-based knowledge and practice, enhancing a competent nursing process. It was in this context that the internships in Intensive Care and Emergency settings took place, these being two spaces for professional and personal development. Understanding the use of knowledge in everyday nursing practice is important for improving the quality of health care. In this sense, the study of the "Severity index of the person who falls in the emergency department" was conducted. Objectives: To characterise the socio-demographic context of fall victims attending the Emergency Department; to identify the clinical determinants of fall victims attending the Emergency Department; to determine the severity index of fall victims attending the Emergency Department; to analyse the influence of socio-demographic, contextual and clinical characteristics on the severity index of fall victims attending the Emergency Department. Methods: This is a quantitative, retrospective cohort, descriptive and correlational study, with clinical data collection to identify the severity index of fall victims who used the Emergency Department of the Centro Hospitalar Tondela-Viseu, from January 1 to December 31, 2020, using the Alert® software, the cause for admission to the "fall" secretariat and the consultation of emergency episodes. We obtained a sample of 679 fall victims, mostly female (54.1%), with a mean age of 69.61 years, predominantly over 80 years old (35.6%). Data collection occurred between September 1 and December 1, 2021, recorded in a grid prepared ad hoc. Results: Most users were taken to the ER by ambulance (63.1%), with a clear predominance of those transported on a stretcher (83.6%). The prevalent triage flowchart was the fall (46.7%), with the discriminator of severe pain (61.1%), triaged with priority orange (98.4%), with urgent clinical area (81.1%) and specialties of orthopedics (43.4%) and surgery (46.3%) in greater representation. Regarding admission diagnosis, femur fractures prevail (19.0%), other trauma and unspecified fractures (17.4%) and head and face trauma (13.8%). Long bone fractures dominated (34%), followed by other traumas (22.1%). The Severity Index corresponds to a minimum score of 3.51 and a maximum score of 7.84, with a mean centered on 7.34. The sociodemographic variables did not interfere statistically in the Severity Index and the clinical variables with statistical interference were priority and clinical area. Patients with priority orange, with minor surgery and whose specialty was orthopedics had a higher Severity Index. Conclusion: The predictor variables of the Severity Index were age, heart rate, pain, Glasgow Reactivity Index, PaCO2, hemoglobin and bicarbonates, systolic blood pressure, pH and PaO2. Age, heart rate, pain, Glasgow Reactivity Index, PaCO2, hemoglobin, and bicarbonates establish an indirect relationship with the Severity Index, while systolic blood pressure, pH, and PaO2 establish a direct relationship. Thus, it was found that as the severity index increases, the better the survival of fall victims treated in the Emergency Department. Keywords: Fall; Emergency Department; Severity Index; Nursing.
Description
Keywords
Acidentes por quedas Enfermagem médico cirúrgica Índice de gravidade de doença Serviço de urgência hospitalar Accidental falls Emergency service, hospital Medical surgical nursing Severity of illness index